Perioperative hemostatic management of patients treated with vitamin K antagonists.
Clinicians, including anesthesiologists, surgeons, and intensivists, are frequently called on to correct coagulopathy in patients receiving oral anticoagulation therapy. Before elective surgery, anticoagulation reversal may be undertaken over several days by discontinuing warfarin or vitamin K treatment, but rapid correction is required in an emergency. European and American guidelines recommend prothrombin complex concentrates (PCCs) for anticoagulation reversal in patients with life-threatening bleeding and an increased international normalized ratio. Compared with human fresh frozen plasma, PCCs provide quicker correction of the international normalized ratio and improved bleeding control. Although there are historic concerns regarding potential infectious and thrombotic risks with PCCs, current PCC formulations are much improved. Recombinant activated factor VII is a potential alternative to PCCs, but preclinical comparisons suggest that PCCs are more effective in correcting coagulopathy. Although many patients who require rapid reversal of warfarin are currently treated with fresh frozen plasma, PCCs should be considered as an alternative therapy.
Levy
Jerrold H
JH
Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322-1061, USA. jlevy01@emory.edu
Tanaka
Kenichi A
KA
Dietrich
Wulf
W
D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology; D001779:Blood Coagulation Factors / Q000494:pharmacology / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control; D019468:Disease Management; D006490:Hemostatics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D019934:International Normalized Ratio / Q000379:methods; D019990:Perioperative Care / Q000379:methods*; D014812:Vitamin K / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000009:adverse effects / Q000037:antagonists & inhibitors
D001779:Blood Coagulation Factors; D006490:Hemostatics; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin